Healthcare Provider Details

I. General information

NPI: 1578889267
Provider Name (Legal Business Name): AMANDA MARIE TROILLETT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S 6TH ST
KLAMATH FALLS OR
97601-6114
US

IV. Provider business mailing address

1030 W OREGON AVE
KLAMATH FALLS OR
97601-1949
US

V. Phone/Fax

Practice location:
  • Phone: 614-578-4980
  • Fax:
Mailing address:
  • Phone: 614-578-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2010010934
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number269727
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: